The URL can be used to link to this page

Home My WebLink AboutZ-30644 FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 30644 Date: 12 20/04 THIS CHRTIFIHS that the building DWELLING Location of Property 920 NAUGLES DR MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 099 Block 0005 Lot 013 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATH OF OCCUPANCY NUMBHR Z- 30644 dated DECEMBER 20, 2004 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH COVERED ENTRY AND CONCRETE PATIO.* The certificate is issued to DONNA KARL (OWNER) of the aforesaid building. SUFFOLK COUNTY DHPARTMSNT OF HBALTH APPROVAL N/A ELHCTRICAL CHRTZFICATB NO. N/A PLUMBERS CERTIFICATION DATBD N/A *PLEASE SEE ATTACHED INSPECTION REPORT. J uthorized Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OP SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATI~: 920 NAUGLES DR MATTITUCK SUBDIVISION: HAP HO.: LOT (S) NAME OP OWN6R (S): DONNA KARL OCCUPANCY: SINGLE FAMILY DONNA KARL ADMITTBD BY: DONNA KARL ACCOMPAHIHD HY: SAME KHY AVAILABLE: SUPP. CO. TAY MAP HO.: 99.-5-13 SOURCE OP RHOUEST: DONNA KARL - 12/10/04 OATH: 12 20 04 DWELLING: TYPB OP CONSTRUCTION: CONCRETE BLOCK 6 WOOD FRAME $ STORIES: 1.0 $ SPITS: 1 FOUNDATION: CONCRETE BLOCK - SLAB C~~*~y: CRAML SPACE: TOTAL ROOMS: 1ST PLR.: 4 2ND FLR.: 0 3RD PLR.: 0 BATHROOM(S): 1.0 TOILBF ROOM(S): 1.0 UTILITY ROOM(S): PORCH TYPE: COVERED ENTRY DECR TYPH: PATIO TYPE: CONCRETE BRHHZ6IN\Y: PIRHPLACE: YES (1) GARAGE: DOMESTIC HOTiATER: YES TYPE HEATER: OIL AIRCONDITIOHIIIG: TYPH HHAT: OIL* NARH AIR: 8OTMATER: OTHHR- *BASEBOARD ACCESSORY STRUCTURES: GARAGE, TYPE OP CONST.: STORAGH, TYPH 01ST.: SHIMMING POOL: GOEST, TYPE CONST.: OTH®t: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM PIKE PREVENTION & BUILDING CODE LOCATION ~ DESCRIPTION ART. ~ SEC. R~anzs: BP749 ADD COZ474; BPJ2849 ADD COZ2716; BP12203 ADD CO211737 INSPHCTED BY: /J~ ~i DATE ON INSPECTION: 12 18 04 MICHAHI. J VERITY TII@ START: 30:30AM HHD: 11:30AM Form No. 6 _ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of properly with accurate locafion of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Swom statement from plumber certifying that the solder used in system contains less than 2/10 of 1 % lead. 5. Commercial building, industrial building, multiple residences and similaz buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy -New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy -Residential $15.00, Commercial $15.00 Date. lal lo~®`>L New Construction: Old or Pre-existing Building: ? (check one) Location of Properly: Qdl~ l~lauttles Drives Ma-F~-c-IzaclC House No. Street Hamlet Owner or Owners of Property: l~onnc~ F<cw ~ Suffolk County Tax Map No 1000, Section X19 Block 5 Lot I Subdivision Filed Map. Lot: Permit No. Date of Pertnit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: ? (check one) 00 Fee Submitted: $ 100 _ ~~u i?/ -30r I~,q~ t~ ~ 1~p IC.a2 ~l(J~T l ~ Applicant Signature 2 02004. AFPIDAVTT 1, DONNA KARL, being duly sworn, attest that the panel of the electrical system at 920 Naugles Drive, Mattituck, New York has not been converted and/or changed in any manner subsequent to 1972. ~11r~ ~titi I~ DONNA xAttl. SwopF~ to before me this O~d'ay of ~.u-~-~,..~K~ 2004 LC; Z Notary Pub ' ~ ~ ~~7 Z 'd 6:41 '~~ti' ONV5~e;'i'd?~11;N ~u'd8%~E b9lil OZ ~;ap CONSENT TO INSPECTION >OI"l Y7Q KQI' ~ ,the undersigned, do(es) hereby state: Owner(s) Name(s) That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold, located at qdn Naucrl~s _D~ Ma~?ucr NV I145d- > which is shows and designated on the Suffolk County Tax Map as District 1000, Section 9 g ,Block 5 ,Lot 19 That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Towrn~ Building Inspector's Office for the following: C.D, i-or Gxi3-I'tna dW~llu'l4 That the undersigned do(es) hereby give con§ent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all / - buildings located therm, to conduct such inspections as they may deem necessary with J respect to the a foresaid application, including inspections to determine that said premises comply with a'1 of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: I I o ~ o'f ~ Kan.O \ (Signature) UOnno~. I<ar I (Print Name) (Signature) (Print Name) SURREY OE PROPERTY 51TU,~TE: M,4TTITUGiG TOWNa 50UTHOLD N SUFFOLK COUNTY, NY ~9d~ SURVEYED II-IQ-2004 W E SUFFOLK COUNTY TAX ~ R~•'_ ~ ~ 1000-99-5-13 Q„~ ~ me^6 S ~,Z a~oe ~ a ~.w~ ~ , dWO ~ ~ ~ ~ ~ tt7 ~ ~ ~ ~ C9 ~ ~ CBRTB~ TO: ~ ~ ` ~ ~ Jaoethm T. Beloer ` (baiatlPn~e PPooBalmr ~ ` , wl.swyass'l~tle Jmmaoce ` , ` , ` , ` , ` , ` , 1 ~ I, 11 Q , 1 ~ , 1 \ g. , 1 \ 1 N ~ ~ , ~ 1 \ , 1 \ ' ' ~ N9 ' y~ 9- < , r. ~ F ~ ~ ~ o 3 3 9- W ~ fl ~ o ~ ,I o ~ O w ~ ~ ~ `g`am i ~ N 3 ~ ~ N 3 fl 3s ~ ~ N ~ ~ ~ ~ 9 N I ` ~ ygss~O ~ ~s . .o C L n `\°e ?9 o`er g',q ;'~`c 6. a ~o ~ ~ ~ ~ ~ O S w ~ aF Fp ~ ° p n 'ys ~ ~ ,5~ A, ~ ~ ~y Q ~ ~b ~ m ye yCd ~ ~ ~ y ~ v`,y 6y ~ ~ ~ d ~ s`b yrW ~ , i ~ & ~ ~ L ~ ~ m4 I i ~ 9 ~`P~~~ a o ~ 85.0A * fl o s'~()°~~~ of Former~\yr°ou55ot fl ~ rna~y Mo yoo $ Pete NOTES: ~ ~u.,~,r~a.,.~ve~.. ~wb, ..,..,.m ~ ~°a~° .a rg rae. a wrciv.. ra w s...y. m µ.e ty w xr vvt bxci°tq~ °i ww°~mswv ~ MONUMENT FOUND ° " ~vd• °r w i.wiy .,irc~.~. cw AREA = 29,Sg1 S.F. or 0.68 ACRE JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 GRAPHIC SCALE I"= 30' RIVERHEAD,N.Y.11901 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\04-327.pm